HomeMy WebLinkAboutEXSY-01-2023-187493.TIF aw ti•`y_, CATAWBA COUNTY Case a EXSY-01-2023-187493
�, Public Health Department Subdivision
Illy,
. s' Environmental Health Division PINT! 279013124663
+\/0 PO Box 389,25 Government Drive,Newton,NC 28658 IMP
Site Address: 4317 S NC 127 HWY,HICKORY NC 28602
Name on Permit HAWKSRIDGE FARMS
Property Size: Acres 65.76
Directions: S NC 127 Hwy,to Hawksridge Farms,on right before Deerfield Subdivision
Owner/Authorized Representative Acknowledgement of Permit Receipt
1 certify that 1 am the owner or authorized agent(owner's authorization required)representing the owner of
X
c property described above.
X
eAs the property owner or authorized representative, 1 have received the above referenced
permit(s)as requested in the application for service EHPR-12-2022-42941,by the following method(s):
Received in Person
______ Facsimile Transmittal(Return form with signature required)
fElectronic Image Transmittal/E-mail (Return receipt required)
glAs the property owner or authorized representative I have reviewed and understand the specific conditions
of the permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(ISA NCAC 18A.1900),
and/or Well Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date:01/12/2023
Owner/Authorized Representative Signature Llto..narkJUttlo
Date 1 1 AO/(M3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time i/1i')3
Method: Fax `r Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoLPlease take a few momentts tto complette our customer service survey att
http://www.surveymonkey.tom/s/EHCusttomerServiry
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catawba county
public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number: EHPR-12-2022-42941 ❑ Reconnection to Existing System
Property Owner/Applicant: Hawksridge Farms ❑ Mobile Home Park Reconnection
Site Address:4317 S NC 127 Hwy, Hickory, NC 28602 _ ® Applicant Request
Type of Facility: ❑ House ❑ Mobile Home Number of Bedrooms 4
❑Business
® Other Migrant housing(480 GPD)
Proposed Addition/Accessory Structure: N/A
®Approved ❑Not Approved Reason
❑Approval Not Required/System Location Only
Evidence of System Malfunction ❑ YES ®NO System Type/Description 11A/Conventional
Noncompliance Items and Notes
• Existing system inspection for continued use of house for migrant housing. House has 4 bedrooms for 8 occupants.
• Permit on file for 4 bedrooms, installed May 13, 1994.
• Do not drive,grade, cut, or fill over septic system area.
• Deck was modified to meet 5' setback to septic tank and supply line
• Noncompliance:N/A
*NOTE: this inspection does not reflect on the lifespan or efficiency of the drainfield.*
Authorized State Agent Blake Perkins Date 1/19/2023
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
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raise from this numb/mod Ems;or the use thereof by any person or (tity, ba County NC 11l 1 L0.23
Evaluation North Carolina Department of Environment and Natural Resources
[ ]Re-evaluation Division of Environmental Health
(number) PREOCCUPANCY EVALUATION REPORT
OF DRINKING WATER SUPPLY AND
�r WASTEWATER FACILITIES FOR MIGRANT HOUSING
On i I
I -1 �)3 ,as required in G.S. 95-225(c)and (d),an evaluation was conducted of the drinking water supply and
(d te)
wastewater system serving a migrant housing site composed of#of 0 Mobile home units,#of 1 House(s) and
Other type of housing/describe: located at Lis 17 S. N G 1Y11 HWl
RI ckor/i N L 2$b 02 and operated by N aW ks" G(ad jce`sm sd rections; use reverse if needed)
�b
of Po 66)( 3341 , H cKpry Nib (na of persons]/company)
L
(mailing address)
*** PLEASE SUBMIT ONE REPORT FOR EACH SEPTIC SYSTEM ***
This report describes well/spring 0 and sewage system i . (Use reverse for a drawing, if needed.)
(number) (number)
The findings of this evaluation are as follows:
WATER SUPPLY
ND Community or non-transient-non-community water system under routine surveillance of Public Water Supply Section,
(yes/no) Division of Environmental Health `
No Private Water or Non-Community System HOQSt Conntther1 +0 �7 J v tic WQ'L1•
(yes/no) {-� I
At the time of inspection,there *vas fl 64 visual evidence of non-compliance with the"Protection of Water Supplies"
(was/was not)
15A NCAC 18A.1700(attach copy of bacteriological sample). List deficiencies which were identified:
(Use reverse if necessary)
WASTEWATERI FACILITIES
r
System JV};,ec,1- to approval under 15A NCAC 18A.1900, "Laws and Rules for Sewage Treatment and Disposal
(subjec/not subject)
Systems." Explain, if not subject to approval
XOn-Site Septic Tank System [[-]Chemical Portable Toilets [ ]Others [ ]Privy(ies)
At the time of inspection,there vslaS f 4 visual evidence of non-compliance with 15A NCAC 18A.1900(including
(was/was not)
.1962)"Laws and Rules for Sewage Treatment and Disposal System." List deficiencies which were identified:
(Use reverse if necessary) Q"
The wastewater sym,to the best of my knowledge and belief, is sized to serve U people.
( \e [/�' ` 1hc& k
�doYY b0( axir}yumUnlber)
environmental Health Specialist Health Department
t I ICI 113 Po Box 3Sci
Date N I AddrressForward copies to: Migrant Housing Operator evikm , , `r c �u 65-
Dep oof Labty& D2O- � 6.5^ q6 17O
Agriculture Safety&Health Bureau '( ,J O /�
Office Phone Number
DENR 3765(Revised 2/2011)
On-Site Wastewater Section(Review 12/2012)